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46
METHUSELAH
Lithium use in pregnancy and the
risk of cardiac malformations
N Engl J Med 2017; 376:2245–54
There has been concern that exposure
to lithium early in pregnancy may be
associated with a marked increase in
the risk of Ebstein’s anomaly and other
congenital cardiac abnormalities.
As the previous data are conflicting,
this cohort study was performed. The
study group included over 1.3 million
pregnancies. The researchers examined
the risk of cardiac malformations among
infants exposed to lithium during the first
trimester as compared with unexposed
infants and, in secondary analyses, with
infants exposed to another commonly used
mood stabiliser, lamotrigine.
Maternal use of lithium during the first
trimester was associated with an increased
risk of cardiac malformations, including
Ebstein’s anomaly as compared with the
unexposed infants. Results were similar
when compared to the lamotrigine exposed
infants. However, the magnitude of this
effect was smaller than had been previously
postulated.
These researchers speculate that adverse
events (AEs), particularly muscle pain
and weakness, to statins have been
overemphasised.
To elucidate this matter, they have reviewed
data from two large trials. In a blinded
randomised trial treatment when atorvastatin
was compared with a placebo, there was
no difference in the incidence of muscle-
related AEs. However, in a non-blinded
non-randomised trial of atorvastatin versus
placebo the incidence of muscle-related AEs
was significantly higher in those taking the
statin.
These analyses illustrate the so-called
nocebo effect, with an excess rate of muscle-
related AE reports only when patients and
their doctors were aware that statin therapy
was being used and not when its use was
blinded. These results will help assure
both physicians and patients that most AEs
associated with statins are not causally
related to use of the drug and should help
counter the adverse effect on public health of
exaggerated claims about statin-related side
effects.
Adverse events associated with statin
therapy?
Lancet 2017; 389:2473–81
Does prenatal use of antidepressants
increase the risk of attention-deficit/
hyperactivity disorder (ADHD) in offspring?
This population-based cohort study
involved nearly 200,000 children. Three
percent of them had a diagnosis of
ADHD. Children whose mothers used
antidepressants in the prenatal period
were compared with those of mothers who
did not. Children whose mothers used
antidepressants before their pregnancy
were also compared with non-users.
The incidence of ADHD was increased
in those whose mothers used prenatal
antidepressants (hazard ratio 1.39). Similar
results were found in the children of
those treated with antidepressants before
pregnancy.
Prenatal antidepressant use and risk
of attention-deficit/hyperactivity
disorder in offspring
BMJ 2017; 357:j2350
Methuselah